250 M. Coombs and M. Woods
of organ donor management that will be explored are the manner in
which discussions are held with families, and the logistic challenges of
retrieving donor organs.
Families of dying and deceased patients in intensive care regularly
talk with doctors during family meetings held in the intensive care unit
(Truog et al. 2008 ). When well conducted, these are associated with
increased family satisfaction with care and greater confidence in hos-
pital staff (Scheunemann et al. 2011 ). Any information given to fami-
lies, such as patient treatment plans and test results, needs to be honest,
considerate, consistent, and delivered in a way that is understandable
to families. This is particularly important in situations where the prog-
nosis is poor (Cook and Rocker 2014 ). For the family of the patient
who is brain dead, there are additional challenges: not only will they
be informed of the death of their family member, they will then be
approached to consider organ donation.
In Tesh’s story, we read how doctors spoke with the family confirming
her brain death, and only after this did they discuss the possibility of
organ donation. This is often termed the ‘decoupling process’ (Siminoff
et al. 2002 ). While it is difficult to appreciate the depth of distress felt
by families at this time, we know that one-third of families who refuse
organ donation, and one in ten families who consent to organ dona-
tion, later come to regret their decision (deGroot et al. 2012 ). Holding
organ donation discussions with families is also stressful for the clini-
cians who increasingly work with donation coordinators to bring spe-
cialist organ donation knowledge into such conversations (Marks et al.
2006 ). This is corroborated by recent Australian research (Mullins
et al. 2012 ) where most of the intensive care consultants surveyed were
trained to talk with families about organ donation but expressed a pref-
erence to work with donor coordinators.
There are many factors that influence families’ decisions about organ
donation. Tesh’s parents did not hesitate in giving their consent for her
organs to be donated, based on their knowledge of who Tesh was in life
and what was important to her. We know that such insight and under-
standing about the deceased strongly influences family members’ deci-
sions to donate (Siminoff and Lawrence 2002 ). However, views held by
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